The Road to Change

The road to Cange, like most roads in Haiti, isnt really
a road. Its a strip of gravel and boulders, punctuated by
deep potholes that stretch across its width. To the left is
mountainside and to the right are huts, some topped with tin
roofs and others with dried banana leaves, and beyond those and
straight down lies a wide plain, which long ago ceased to produce
anything nourishing. Apart from mango trees and a few shrubs, the
landscape is desolate. The people who live in this central
plateau area are among the poorest in Haiti, a country that is
among the poorest in the world.

A few miles to the east lies a different country, lush, with
an apparently thriving population. According to the U.S. State
Department, the Dominican Republics economy was one of the
fastest-growing in the hemisphere over the past decade. More than
80 percent of its population is literate, and life expectancy is
over 70 years. In contrast, Haitis economy has actually
shrunk. Only half of the people of Haiti can read and write, and
extreme poverty and disease - most of it treatable - shorten the
life expectancy to about 50. The two countries share the same
island; a visitor from another world might wonder, does the sun
not shine on Haiti?

Extreme political, economic, and social instability
characterize Haitis history, from its early colonial days
when slaves were brought in to work the sugar cane fields and
coffee plantations - slaves who after their successful revolt
were forced to pay "reparations" to their French
slaveowners - all the way to the present. Current news reports
cite the "new" wave of violence surging in
Port-au-Prince slums and elsewhere - specifically the kidnappings
of those considered ransom-worthy - but it isnt really new.
Tactics may change, but the violence doesnt: Structural
violence begets episodic violence. Those reports fail to mention
the systemic oppression Haiti has endured by its own elite as
well as by countries such as the United States that have blocked
aid, removed democratically elected presidents, and enforced
trade policies that exploit the Haitian labor force.

The United States took some positive action in 2004 in
providing $180 million to Haiti for civil conflict, flood, and
hurricane relief, with $40 million for humanitarian assistance,
according to the U.S. Agency for International Development. There
are also bills pending that would amend the Immigration and
Nationality Act to grant special visa status for Haitian families
separated by immigration to the United States. Concrete steps,
yes, but small in the face of Haitis seemingly
insurmountable challenges.

BUT ABOUT THREE hours drive northeast of Port-au-Prince,
a distance of about 35 miles, the road to Cange rounds a bend and
the walls of a hospital emerge from the foliage. Zanmi Lasante
(Creole for Partners in Health) treats the poorest Haitians for
free, and has for more than 20 years. Hundreds of people sit in
the shaded courtyards and lie on the low stone walls lining the
walks, waiting to be seen by clinic founder Dr. Paul Farmer and
his colleagues.

Its a luxury to be seen by a doctor at all, let alone in
such a comprehensive way. Patients who need to get to Cange for
treatment are given transportation money to travel there and food
to eat, so they can take their medicine. Community health workers
trained by Zanmi Lasante travel throughout Haitis central
plateau to care for those too ill to travel, make sure patients
take their medicine and have enough food, or arrange for homes to
receive concrete floors.

The health center is a bright spot in a country that needs
relief in every form, and it represents a strategy that is
working in a country much of the world has forgotten. "Even
in situations that seem overwhelming, you try to focus on the
individual patient," Dr. Farmer recently told a New York
Times reporter. "At the same time, you develop
strategies to change the larger picture." And changing that
larger picture is exactly whats needed if the sun is ever
to shine on a renewed Haiti.

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